Arabkhazaeli Moona, Umeh Genevieve, Khaksari Bijan J, Sanchez Lauren, Xie Xianhong, Plewniak Kari
Department of Obstetrics and Gynecology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
Department of Epidemiology and Population Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
JSLS. 2021 Jan-Mar;25(1). doi: 10.4293/JSLS.2020.00088.
Examine trends in opioid prescriptions after laparoscopic sterilization over time, and identify any individual patient, provider, or procedural factors influencing prescribing.
A retrospective observational cohort analysis of laparoscopic sterilizations between January 1, 2016 and December 31, 2019 at Montefiore Medical Center. A review of the medical records was performed and information on patient demographics, comorbid conditions, and surgical characteristics were collected. The number of opioid pills prescribed postoperatively and any pain related patient calls, visits, or refills was recorded.
Between January 1, 2016 and December 31, 2019, 615 laparoscopic sterilizations were performed. The median number of opioid pills prescribed was 10, ranging from 0 to 40. There was a significant decrease in the number of opioid pills prescribed (p < .0001) and refill incidence (p < .001) over time. Patients with a documented diagnosis of pelvic pain received significantly more opioid pills (p = .02), as did patients who underwent tubal occlusion versus salpingectomy (p = .01). There was no association between the number of opioid pills prescribed and other patient or procedural characteristics. Finally, the number of pills prescribed was not associated with urgent patient contact (p = .34).
The overall number of opioid pills prescribed after laparoscopic sterilization decreased at our institution over time, which paralleled a decrease in refills and urgent postoperative patient contact. Further, few clinical characteristics influenced postoperative prescribing and there was no association between number of pills prescribed and urgent patient contact. These findings suggest excess prescribing and highlight the need to identify and adopt an evidenced-based approach to postsurgical opioid prescriptions.
研究腹腔镜绝育术后阿片类药物处方随时间的变化趋势，并确定影响处方开具的任何个体患者、医疗服务提供者或手术因素。
对2016年1月1日至2019年12月31日在蒙特菲奥里医疗中心进行的腹腔镜绝育手术进行回顾性观察队列分析。查阅病历并收集患者人口统计学、合并症和手术特征等信息。记录术后开具的阿片类药物片数以及任何与疼痛相关的患者呼叫、就诊或续方情况。
2016年1月1日至2019年12月31日期间，共进行了615例腹腔镜绝育手术。开具的阿片类药物片数中位数为10片，范围为0至40片。随着时间的推移，开具的阿片类药物片数（p < 0.0001）和续方发生率（p < 0.001）显著下降。有盆腔疼痛诊断记录的患者接受的阿片类药物片数显著更多（p = 0.02），接受输卵管阻塞术而非输卵管切除术的患者也是如此（p = 0.01）。开具的阿片类药物片数与其他患者或手术特征之间无关联。最后，开具的片数与患者紧急联系情况无关（p = 0.34）。
随着时间的推移，我院腹腔镜绝育术后开具的阿片类药物片数总体下降，这与续方减少和术后患者紧急联系情况减少相平行。此外，很少有临床特征影响术后处方开具，且开具的片数与患者紧急联系情况之间无关联。这些发现提示存在过度处方现象，并凸显了识别和采用基于证据的术后阿片类药物处方方法的必要性。
